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, <br /> p8����� PuGbc Work�G�rmil� _�� / <br /> AppllceHon For eiaa o.oi.• <br /> PUBLIC WORKS PERMIT P°°;;;°;:F•• . � -- <br /> uu�no�Fe•r.m f�_ <br /> B�bncnDu� S �� �— <br /> Print or Type Only <br /> B 6 R Aaeociatee 1429 Broadway Everett 98201 252-1166 <br /> 4wne� Mailing AdAress City 2ip Phone <br /> S.�me <br /> App!Icent Malling Addrees City Zip Phone <br /> Dosc�lbeProposedWork ,�P�cr cX/J'T/n)G �.�Yf/p c�i�'/9�iv/9G'f <br /> f�/�'c Gr/� .Dur'T/L E /�Po� -�a2. �� O/1��y <br /> u,� — co.vs�u�T���.� ��.,e ,� - W <br /> �ect Addreee 1�1 known� 1625 A—B—C—D Cheetnut Street � <br /> Attech fOUf�4)COpIBe OI plen9 IOr prOpOaBd work• DreW t0 BC810 end nate th0 IOIIOwing ea eppliceble. �� <br /> • Property Lines • Centerline ol slreet � <br /> • Outline end dimenalone ol ell exisling end • Indicate North <br /> proposed structuree on the lol � Show any proposed grading changea <br /> • E�Islinp end proposed utllltlee • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All celle for inspectlon eholl be mede 24 hrs. in edvance- phone 259•881 5. � <br /> 2. All work ahdll be pertormed in accordence with this permll end current Clly ol Everett Dealgn end Conslruction <br /> Stendards and Specilicationa <br /> 3. Call Locatlon Underpround Servlte 48 h�s. belo�e you diB.TOLL FREE NUMBER 1�800•424•5555. � <br /> � �� � u%/C/Ty Ef,EJ'L/�ICi+I� �S /P�G!/.�'��p O <br /> 5,e�, �a '� �-a ric�- �'i.d'�; E/'cr S�'���✓T <br /> /S .a.�is�'i9iZr — itJvi �'uc�LsC' . � <br /> � <br /> S �v�j7�/T /�� J��i .-/l�c�c �/�c o�JL1! Q <br /> ,t'- o_ ,�v. ��.�,e�-�--�r ��s ��%� � <br /> �.� si�c�� i�li�rv��j�-.��' - .sr��s�'�n-� <br /> , �/� �� 1.s�1'uc�. <br /> ��/T ACKNOWIEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicanl hereby ap�ees to hold and eave harm• <br /> less lhe City ol Everelt Irom eny and all clalms �or damBge& cosl& <br /> ecpenses, or caures of ection Ihet mey erise ber,euse ol Installation <br /> � �p OS and malntenence ol the improvement or other right-of�way use he�eto <br /> � � applied lor and lurther agrees lo �emove same upon nolice Irom the <br /> App�p+� ona clio Dele City end to raplace pubtic property demeped thereby. <br /> /�- 3-�!� �� �.�d-����. �- �a ►-8 S <br /> FINAL INSPECTION Da�e <br /> Approved as Conetructed Signature ol Applicant Dete <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STAiiTED WITMIN <br /> � 3200 Cader Sireet 180 DAYS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLV PURSUED TO CUMPLETION. THIS PERMIT MAV BE <br /> Phone: 253-BB15 CANCELLED BY THE CITV UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 OAYS DURATION. <br />